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It rises in north central Wyoming, approximately twenty miles west of Devil's Tower. It flows northeastward, across a corner of southeastern Montana, and into South Dakota. In South Dakota, it flows northward through the Badlands into North Dakota, crossing the Little Missouri National Grasslands and both units of Theodore Roosevelt National Park. In the north unit of the park, it turns eastward and flows into the Missouri, where it has been dammed to create the reserovior Lake Sakakawea. The arm of the reservoir formed by its lower reaches is called Little Missouri Bay.
See: List of Wyoming rivers, List of South Dakota rivers, List of Montana Rivers, List of North Dakota rivers